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Pathophysiology > Ch-19 Alteration in Hormonal Regulation > Flashcards

Ch-19 Alteration in Hormonal Regulation Flashcards

1
Q

What are the two diseases of posterior pituitary?

A

SIADH & Diabetes insipidus

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2
Q

What is another name for ADH?

A

vasopressin

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3
Q

If there is no ADH, the collecting duct is ____ permeable to water and large volume of urine is produced.

A

NOT

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4
Q

If there is an excess secretion of ADH from PP = water ____(1) & ___-osmolarity (2)

If there is a reduced secretion of ADH from PP = water _____(3) and ECF _____osmolarity (4)

A

reabsorption (1); hypo (2); absorption (3); hyper (4)

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5
Q

Which disease of PP occurs when there is a presence of high ADH levels?

A

SIADH

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6
Q

What are the common causes of SIADH? (3 pts)

A

(1) ectopic secretion of ADH by tumours
(2) surgery
(3) meds

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7
Q

What type of meds are associated with SIADH?

A

HYPOglycemic meds, opioids, antidepressants, anti-inflammatory

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8
Q

What tumours are associated with SIADH?

A

Cancers - stomach, duodenum, pancreas

Lymphomas, sarcomas (bone cancers)

CNS disorders - encephalitis and meningitis

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9
Q

How does surgery affect SIADH?

A

any surgery increased ADH up to 5-7 days

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10
Q

What is the key feature of SIADH?

A

increased water reabsorption to peritibular capillaries.

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11
Q

For SIADH, if there is increased ADH secretion, there is _____(1) water channel proteins.

A

increased

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12
Q

SIADH: If there is an increased water reabsorption in ECF = ___-____ in ECF

A

hypo-osmolarity.

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13
Q

What is the difference between normal osmolarity/ hyperosmolarity/ hypo-osmolarity?

A

Normal: match between Na and H2O

HYPER: more Na than H2O

HYPO: less Na than H2O

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14
Q

What are some manifestations for SIADH?

A

HYPOnatremia – low Na in blood

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15
Q

What are the effects of SIADH in our body?

A

dependent upon severity and rapidity of onset

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16
Q

How much does the serum Na levels decrease if people has SIADH?

Note: It decreases rapidly!

A

140-130 mmol/L

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17
Q

How much is the serum Na level of a person with SIADH if they are showing symptoms like VOMITING, ABDOMINAL CRAMPS & WEIGHT GAIN?

A

130-120 mmol/L

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18
Q

How much is the serum Na level of a person with SIADH if they are showing symptoms like CONFUSION, LETHARGY, MUSCLE TWITCHES & CONVULSIONS?

A

below 130 mmol/L

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19
Q

T or F: Symptoms of SIADH usually resolve with correction of hyponatremia.

A

TRUE

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20
Q

Which PP disorder is associated with insufficiency of ADH activity leading to polyuria and polydipsia?

A

diabetes insipidus

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21
Q

What is polyuria and polydipsia?

A

polyuria – fq. urine

polydipsia – fq. drinking

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22
Q

What are the 2 forms of diabetes insipidus?

A

Neurogenic (or central) & Nephrogenic

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23
Q

What are the 2 types of Nephrogenic?

A

acquired and genetic

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24
Q

What is the cause of Neurogenic?

A
  • low ADH from PP
  • lesions on hypothalamus
  • PP interference with transport/release of ADH
  • brain tumours, aneurysm
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25
Q

T or F: Diabetes insipidus is a well-recognized complication of TBI.

A

TRUE

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26
Q

Acquired or Genetic DI: Related to medication disorders that damage renal tubes.

What are the associated disorders?

A

ACQUIRED

Polycystic & Pyelonephritis

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27
Q

What is polycystic and pylonephritis?

A

Polycystic kidney disease – gen. disorder that cause many fluid filled cysts to grow in kidneys

Pylonephritis – urinary tract infection

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28
Q

Acquired or Genetic DI: Mutation of gene coding for aquaporon-2.

A

Genetic DI

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29
Q

What is the associated mutation for genetic DI?

A

aquaporon- 2

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30
Q

What is a rare DI?

A

if its associated with pregnancy.

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31
Q

T or F: DI with pregnancy requires tx.

A

FALSE; doesnt require tx and is usually mild

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32
Q

DI with pregnancy: Increase in level of vasopressin-degrading enzyme ______

A

vasopressinase

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33
Q

For DI: Insufficient ADH = large volume of ____ (1) urine = _____ (2) plasma osmolarity

A
  1. dilute
  2. increased
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34
Q

T or F: Serum HYPERnatremia and HYPERosmolarity is associated with DI

A

TRUE

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35
Q

What are some clinical signs for DI? (3pts)

A

polyuria
nocturia
polydipsia

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36
Q

What is nocturia?

A

walking up at night to urinate

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37
Q

What is the normal urinary output? What is pt with DI’s urinary output?

A

Normal urinary output: 1-2L/day

DI urinary output: 8-12L/day -can be higher than daily fluid intake.

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38
Q

What is the result of longstanding DI?

A

enlarged bladder capacity & Hydronephrosis.

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39
Q

What is hydronephrosis?

A

swelling of one or both kidneys

40
Q

What is the difference in terms of onset between nephrogenic DI and neurogenic DI?

A

Nephrogenic DI: gradual onset

Neurogenic DI: sudden onset

41
Q

What are some diagnosis for DI? (4pts)

A
  • dilute urine
  • hypernatremia
  • hyperosmolarity
  • continue diuresis
42
Q

What are some tx for DI?

A

-ADH replacement
- oral or IV fluid replacement
- NEW tx: reversing acquaporing-2 dysfunction
- meds like carbamazepine (e.g., Tegretol)

43
Q

Thyroid function disorder is due to ____ (1) dysfunction of ____ (2) gland.

A
  1. primary
  2. thyroid
44
Q

Why does secondary dysfunction of thyroid gland occurs?

A

because of pituitary or hypothalamic alterations.

45
Q

What is a subclinical thyroid disease?

A

thyroid disease with NO symptoms but AB lab values.

46
Q

What is the difference between HYPErthyroidism & Thyrotoxicosis?

A

Thyrotoxicosis – CONDITION that result in any cause of INCREASED thyroid hormone levels

HYPERthyroidism – EXCESS secretion of thyroid hormone from thyroid gland.

47
Q

What are disease associated with HYPERthyroidism? (2pts)

A
  1. Graves Disease
  2. Toxic multinodular goiter
48
Q

What are some features of thyrotoxicosis?

A

caused by metabolic effects of INCREASED serum thyroid hormones.

49
Q

For thyrotoxicosis: If there is increased metabolic rate = there is increased _____ _____ (1) tolerance = increase tissue sensitivity to SNS stimulation

A

heat intolerance

49
Q

What are some differences between HYPO and HYPER? (5pts each)

A

HYPOthyroidism
- periorbital edema
- constipation
- edema of extremities
- bradycardia
- smaller thyroid

HYPERthyroidism
- enlarged thyroid
- exopathalmos
- diarrhea
- pretibial edema
- tachycardia

49
Q

What is the difference between exopathalmos and periorbital edema? Which symptoms is associated with hypo and hyper thyroid?

A

Exopathalmos – bulging protruding eyeballs; HYPER

Periorbital edema – swelling around eyes – HYPO

49
Q

What percentage of Graves’ Disease leads to the underlying cause of hyperthyroidism?

A

80%

49
Q

T or F: Graves’ disease is more common in women. Also the exact cause is unknown.

A

TRUE

49
Q

Graves’ disease is an ______ (1) disease. As a result, ______(2) stimulate receptors on thyroid gland.

A

autoimmune (1); autoantibodies (2)

49
Q

What antibodies override normal regulatory mechanisms in Graves’ disease?

A

thyroid-stimulating immunoglobulins (TSIs)

49
Q

In Graves’ disease, TSI stimulation = _______ (1) of gland and ______ (2) secretion of TH (esp T_ (3))

A
  1. hyperplasia
  2. increased
  3. T3
49
Q

Manifestations of Graves disease due to TSIs? (2pts)

A
  1. ab from HYPERACTIVITY of SNS
  2. Change of orbital contents with ENLARGEMENT of orbital muscles
50
Q

What are the results of the manifestations of Graves’ disease?

A
  • Exopathalmos, Diplopia, & decreased visual acuity.
  • Pretibial myxedema
50
Q

What is the difference between diplopia and exopathalmos?

A

diplopia – double vision

exopathalmos – protusion of eyeball

50
Q

What is pretibial myxedema?

A

subcutaneous swelling of anterior portion of legs.

50
Q

What is the cause of the swelling of pretibial edema?

A

recruited T cells stimulate excessive amounts of hyaluronic acid.

51
Q

What is hyaluronic acid?

A

a natural substance found in fluids in eyes and joints

52
Q

What is toxic multinodular goitre?

A

several nodules increase in size and increase TH output, thus increases size of thyroid gland.

53
Q

What are some characteristics of thyrotoxic crisis/

A
  • rare
  • dangerous – death can occur within 24 hrs without tx.
  • occurs in individuals having Graves’ disease and subjected to infection, pulmonary or cardiovascular disorder.
54
Q

T or F: Thyrotoxic crisis can occur due to thyroid surgery.

A

TRUE

55
Q

What is the difference between primary and central (secondary) hypothyroidism?

A

Primary – accounts for most cases

Central – related to pituitary, or hypothalamic failure.

56
Q

What is the common cause of primary hypothyroidism in Canada?

A

autoimmune thyroiditis (Hashimoto’s disease)

57
Q

What is the cause of autoimmune thyroiditis?

A

infiltration of autoreactive T cells, NK cells, and induction of apoptosis

58
Q

What does autoimmune thyroiditis leads to?

A

gradual inflammatory destruction of thyroid tissue.

59
Q

What thyroid disorder occurs in infants when thyroid tissue is absent or with hereditary defects in TH synthesis?

A

Congenital Hypothyroidism

60
Q

T or F: TH is essential for embryonic growth particularly brain tissue.

A

TRUE

61
Q

Fetus is dependent upon maternal (_____ (1) wha type of TH) for the first ____(2) weeks of gestation. Thus lack can result in ______ (3) defects.

A

T4 (1); 20 weeks (2); cognitive (3)

62
Q

What are some symptoms of congenital hypothyroidism? (3 pts)

A
  • high birth weight
  • hypothermia
  • neonatal jaundice
63
Q

For congenital hypothyroidism, ______ (1) cord examination can provide T___(2) & ____ (3) levels.

A

umbilical (1); T4 (2); TSH (3)

64
Q

What is the tx for congenital hypothyroidism?

A

levothyroxine BEFORE child is 4 months old

65
Q

T or F: Without screening, hypothyroidism may be difficult to determine before 4 months

A

True

66
Q

What are the symptoms of congenital hypothyroidism? (4 pts)

A

difficulty eating, horse cry, PROTRUDING CRY, excessive sleeping.

67
Q

What is the most common pediatric chronic disease? What % of Canadians have this form of diabetes?

A

Type 1 diabetes mellitus; 10%

68
Q

T or F: Type 1 Diabetes Mellitus has only association with environmental factors like meds and viruses.

A

FALSE; HAS BOTH ASSOCIATION WITH GENETIC AND ENVIRONMENTAL FACTORS.

69
Q

Pathophysio of Type 1 DM: There is a ___ (1) progressing autoimmune __-_____-_____ (2) disease that destroys _____ (3) cells.

In terms of genetic environmental interaction, there is formation of ______ (4) expressed on pancreatic ____ (5) cells. Thus autoantigens detach/circulate in bloodstream and lymphatics. As a result, there is activation of __-____ (6) cells and _____ (7) and production of autoantibodies occurs.

These effects result in pancreas ___ ____ (8) destruction = reduced _____ (9) secretion.

A
  1. slow
  2. T-cell-mediated
  3. pancreatic
  4. autoantigens
  5. beta
  6. T-cytotoxic
  7. macrophages
  8. beta cell
  9. insulin
70
Q

Type 1 DM: For insulin secretion to decline enough that ______ (1) develops ____-___% (2) of beta cells must be destroyed.

A
  1. hyperglycemia
  2. 80-90%
71
Q

Manifestations for Type 1 DM?

A
  • insulin deficiency and hyperglycemia situation
  • glucose build up in urine and blood — results in diuresis = dramatic increase in thirst
72
Q

With type 1 DM, the lack of insulin, ____ (1) and ____ (2) become utilized leading to high levels of circulating KETONES, causing _____ _____ (3)

A
  1. fats
  2. proteins
  3. Diabetic ketoacidosis
73
Q

Type 2 DM accounts for ___% of all diabetes in Canada.

A

90%

74
Q

What are the risk factors for Type 2 DM? (5 pts)

A

age, obesity, hypertension, physical activity, family history

75
Q

The occurrence of type 2 DM linked to more than ___ (1) genes which code for ___ (2) cell mass and functionality.

Resulted 2 mechanisms: _____ ____ (3) & decreased ____ ____ (4) by beta cells

A
  1. 60
  2. beta
  3. insulin resistance
  4. insulin secretion
76
Q

What is metabolic syndrome?

A

a list of disorders predict a high risk type 2 DM

77
Q

Type 2 DM Pathophysio:
A ___-___ (1) response of insulin- sensitive tissue (esp, liver, muscle and adipose tissue) = condition of ____ (2) resistance

What are the the mechanisms involved?

A
  1. sub-optimal
  2. insulin

Three mechanisms:
1. Obesity
2. Elevated levels of free fatty acid
3. obesity link to hyperinsulinemia

78
Q

What is beta-cell exhaustion?

A

decrease beta-cell mass and dysfunction of normal beta cell function

79
Q

What syndrome is associated with chronic exposure to excess cortisol?

A

Cushing’s syndrome

80
Q

People with cushing’s syndrome have chronic exposure to excess ____

A

cortisol

81
Q

Cushing’s disease is the result of excess secretion of ____ (1) by anterior pituitary or an _____-_____ (2) nonpituitary tumour.

A
  1. ACTH
  2. ectopic-secreting
82
Q

Pathophysio of CD (hypercoticolism):
1. Normal ____ (1) secretion patters of ACTH and corticol are ____ (2).

  1. There is ____ (3) increased ACTH and cortisol secretion in response to ____ (4)

Result:
Excess ACTH secretion but loss of ____- _____ (5) controls on ACTH secretion.

Symptoms of _____ (6) develop

A
  1. diurnal
  2. lost
  3. no
  4. stress
  5. negative-feedback
  6. hypercorticolism
83
Q

What are the manifestations for Cushing’s disease?

A
  • weight gain – face, trunk, buffalo hump
  • weakened integumentary tissue = stretched skin
  • suppression of immune system
  • vertebral compression fractures, kyphosis, and reduced height.
84
Q

What is kyphosis?

A

outward curvature of the spine “humpback”

Pathophysiology (20 decks)

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